Some people are going to have challenges with condom use no matter what we do.
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Behavior change is very difficult, even when the stakes are high. Despite all that we know about the dangers of tobacco, millions continue to smoke. We also know that we should exercise and eat well, yet obesity is on the rise. Until now, adopting safer behaviors—including condom use—has been the only option available for people who wished to protect themselves from becoming infected. Lots of people were able to successfully change their behavior in the late s and early s, so much so that the rate of new infections dropped by an amazing degree.
Since then, however, helping people maintain safer behaviors or getting younger people to adopt them has gotten a lot harder. In fact, more than 50, people are estimated to have become infected each year since the mid- to lates. Among gay and bisexual men, new cases are actually on the rise, especially for young black and Latino men. There are many external factors that contribute, too. These include poverty, homophobia, racism, homelessness—all of these things can significantly increase HIV risk while also contributing to significant health disparities across various racial and socio-economic groups.
We desperately need new tools in order to turn things around. Now that PrEP has been shown to be effective in clinical trials, the next step is to determine whether and how PrEP can be used to reduce HIV infections in communities. Taking a pill every day to prevent something from happening to your body is not a new or foreign concept.
Currently, there are over 10 million women in the United States who take a pill every day to prevent pregnancy. Both are equally important. The science and evidence are there to prove that this HIV prevention strategy works. Ethical questions around access, affordability, and distribution are ones we are trying to address with partners at the local, state, and federal levels.
Advocates are committed to investing in ending AIDS—which prioritizes making sure all people living with HIV have access to HIV treatment and also that HIV-negative people have access to use the tools they need to prevent them from getting infected in the first place.
Who is this strategy meant for and how does it prevent HIV? The clinical studies often lump these groups together. All of the participants also got safer sex counseling and condoms, regular sexually transmitted infection STI check-ups and treatment, and HIV testing. When the researchers compared people assigned to take Truvada with those assigned to take the placebo, they found that people who were given Truvada had lower HIV infection rates compared to people who were given placebo.
More research needs to be done to figure out if hormones interact with Truvada and change its HIV protection effectiveness, but no interactions have been reported to date. More research needs to be done to figure out the safety and effectiveness of PrEP for people who are younger than 18 years old. There are studies underway with the Adolescent Trials Network trying to answer this question. PrEP is not the right fit for everyone but may be useful for men, women, and trans women who are at risk for HIV infection through sex and injecting drug use and okay with the idea of taking a daily pill to prevent HIV.
If you have been exposed to HIV, PrEP is not the best option for you because it is meant to reduce your risk before exposure. If you are reading this within 72 hours after exposure, consider starting PEP short for post-exposure prophylaxis , a month-long course of drugs that can reduce the likelihood of infection. PEP must be started within 72 hours after exposure. As a disclaimer, remember that PrEP does not protect you against other STIs, like gonorrhea or syphilis, or prevent pregnancy. Also on a similar note, sharing medications with each other is a big no-no.
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Not only does sharing mean your partner could run out of meds unexpectedly and be at risk for developing drug resistance , the medications your partner takes may not be the same ones used in safe and effective PrEP. Yes, PrEP is one of many options available to you as you make decisions about how to safely conceive and have a family. While there is research showing that PrEP works for HIV prevention for adult heterosexual women and men, more research needs to be done on women using PrEP during pregnancy.
As the hopeful soon-to-be dad or soon-to-be mom, there are many things to consider that you should discuss with your partner and doctor— general health, fertility, STIs, HIV viral load of the HIV-positive partner, and risk of HIV transmission—before trying to get pregnant. It is essential to discuss with your partner and doctor what HIV prevention strategy works best for you to ensure a healthy pregnancy and minimize your risk of acquiring HIV.
When considering PrEP, it is important to remember that medications used for HIV treatment and prevention are different, so it is not as simple as sharing medications between partners. Read: Do not try this on your own; sharing medications with each other is a big no-no. There are many options available now to prevent HIV.
Of course, just like condoms, PrEP only works if you use it. Condoms have been and continue to be an effective tool in reducing HIV risk, but we know that many people are already not using condoms each and every time they have sex.
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There are other options available too. Some methods are more effective than others depending on a variety of different factors. It all depends on what you find works best for you and how comfortable you are with different levels of HIV risk. PEP, post-exposure prophylaxis, is medication taken immediately after exposure to HIV within 72 hours and continued for 28 days. HIV drug resistance means certain medications will no longer keep the virus in check if you are HIV-positive.
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For this reason, it is really important that before you start using PrEP, you get tested for HIV using an RNA test , which looks for the actual presence of virus in your blood. There are studies underway to explore other drug options. Remember, HIV today is a manageable disease. Work with your doctor to get linked in to HIV care and start getting the treatment you need to maintain your health. If you are located in San Francisco, please check out our Positive Force program, offering easy, understandable, and non-judgmental ways to help you get the healthcare and support you need.
Sharing medications is a big no-no. This HIV prevention strategy is something that would need to be discussed with and monitored by your doctor. You will need to have lab work done to monitor side effects and your kidney function.
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For example, if you start taking PrEP because you are sexually active with multiple partners who are HIV-positive and HIV-negative, and later you find yourself in a relationship where you and an HIV-negative partner are committed to having sex with only each other, then continuing to take PrEP might not make a whole lot of sense for you. Or maybe you start PrEP when you are in a serodiscordant relationship, then that relationship ends and you have no sexual partner for the next six months; then it might not make sense to take PrEP.
With proper guidance, people can safely start and stop taking PrEP. It only works if you take it correctly and consistently. There are not enough data available to provide specific timing guidance on non-daily use, so the FDA recommends PrEP be used daily to achieve the highest level of protection.
Ask your doctor. You can discontinue using PrEP whenever you decide the protection it offers is no longer necessary, if you experience complications related to PrEP, or if you cannot manage to take a pill daily. According to studies, most people who experience nausea while taking PrEP stop feeling nauseated after about a month of taking the drug.
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You might also consider switching the time you normally take your drug; taking it at night might allow you to sleep through the nausea, for example. For the first few weeks of starting Truvada for PrEP, some people complain about nausea, vomiting, fatigue, and dizziness, with these minor symptoms eventually resolving themselves over time. Some people in clinical trials had elevations in blood tests that looked at kidney function. With this particular side effect, there were no physical symptoms, so it is important to remember that if you take PrEP, you need to get routinely checked by your doctor to make sure your kidneys are working properly.
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Some people in studies had a decrease in bone mineral density within the first month. However, but these changes were small, did not progress over time, and did not increase risk for fracture. Once Truvada was stopped, the bone mineral density returned to normal. To develop HIV drug resistance means certain medications will no longer keep the virus in check if you are HIV-positive. No, you cannot get HIV from Truvada. The medications in Truvada work to prevent HIV from establishing infection inside the body.
Alcohol and recreational drugs are not known to interact with Truvada for PrEP. It is safe to take PrEP after a night on the town. It is important to work with your doctor to monitor any potential long-term effects. For people who are living with HIV and taking Truvada for long-term HIV treatment, there are concerns about increased kidney function and decreased bone mineral density. Bottoms are already at much greater risk for HIV than tops. One of the great things about Truvada for PrEP is that the drugs are known to be very good at protecting people from infection during receptive anal intercourse.
After you swallow the pill and Truvada is absorbed into your body, much of it winds up in your colorectal tissue—ready to fight any HIV that it encounters. If you fall into this camp, PrEP might be right for you.
You are considering using PrEP and you want to know how to prepare and learn about how you can get it. Here are some questions that might come up in conversation:.
You should expect to see your doctor every 2—3 months for follow-up. If you are getting PrEP through a clinical trial or demonstration project, then you may see your doctor more often.